Proteção social em saúde: Um balanço dos 20 anos do SUS

Abstract

The creation of the Unified Health System by the 1988 Brazilian Constitution, based on the principle of universality and within a wide approach of Social Security, was an important alteration in the history of health care protection in Brazil. This paper presents a conceptual debate on health care protection and discusses the trajectory and main historical-structural characteristics of the Brazilian health care security up to the 1980's, emphasizing its health expressions. Then it analyzes the 20 years of the SUS, based on the analysis of changes and follow-ups in four dimensions selected to feature health care protection in Brazil: institutional organization; financing; public-private mix and health care model. Finally, it discusses the main difficulties and current challenges concerning the expansion of health care security in Brazil.